Potassium Citrate is Better in Reducing Salt and Increasing Urine pH than Oral Intake of Lemonade: A Cross-Over Study

Abstract

BackgroundUrine solute supersaturation leads to the formation of urinary tract caliceal stones. Many parameters can be involved in the supersaturation of solutes in urine, such as pH. Uric acid has pKa ≤5.5, and it is solubilized at pH ≥5.5. The objective of the study was to evaluate the effects of potassium citrate and lemonade supplementation in pediatric patients with urolithiasis.Material/MethodsA total of 126 children who had lower ureteral stones calculi and fragments with severe colic pain participated in this cross-over study. Children drank lemonade (2 mEq/kg/day citrate) in 3 divided doses for 5 days. After a 15-day washout period, children drank 2 mEq/kg/day of potassium citrate in 3 divided doses for 5 days. On the sixth of the day of individual intervention, a 24-h urine sample was collected and evaluated for pH, urine volume, citrate level, uric acid level, magnesium, phosphorus, potassium, and sodium. Urinary parameters for 1-day urine collection measurements after each supplementation were compared with baseline using the Mann-Whitney test following Tukey post hoc test at 95% confidence level.ResultsPotassium citrate supplementation resulted in reduction of sodium concentration (p=0.0337; q=3.76) and increased pH of urine (p=0.0118; q=4.389). However, urine volume, citrate level, and uric acid level, as well as elemental magnesium, phosphorus, and potassium, remained unchanged after 5 days of supplementation with potassium citrate or lemonade.ConclusionsPotassium citrate supplementation is an effective therapy for preventing pediatric urolithiasis, with acceptable adverse effects.

Pharmacological interventions for the management of cystinuria: a systematic review

“…Only five studies reported the doses of alkalinizing agents and their treatment outcomes (Table 4 ) [ 11 , 19 , 20 , 25 , 26 ]. Potassium citrate (60–80 mEq/day [ 25 ] or 1 mEq/kg/day [ 11 ] or 40 to 70 mmol/day[ 20 ]) and sodium bicarbonate (8–18 g/day [ 19 , 25 ] according to body weight or 47.6–107 mmol/day [ 20 ]) were used to increase urinary pH levels by increasing the excretion of free bicarbonate ions without producing systemic alkalosis [ 36 ].…”

“…Potassium citrate and sodium bicarbonate are the most commonly used alkalinizing agents. Potassium citrate is more effective in reducing sodium concentration and increasing urine pH [ 20 , 36 , 42 ]. Prophylactic treatment with Shohl’s solution, a combination of potassium citrate and citric acid, also increases urinary pH levels and decreases urinary cystine concentrations [ 26 ].…”